Rx15 ea tues_330_1_lovedale_2holton_3varney-edwards

Education and Advocacy Track
Collaboration, Coordination & Data:
Three Keys for State Progress
Presenters:
• Laurie Lovedale, MPH, CPS II, Manager, Prescription Drug Abuse
Prevention Program, Peer Assistance Services, Inc.
• Dwight Holton, JD, CEO, Lines for Life
• E. Douglas Varney, Commissioner, Tennessee Department of
Mental Health and Substance Abuse Services
• Karen Edwards, PhD, Research Director, Tennessee Department
of Mental Health and Substance Abuse Services
Moderator: Regina M. LaBelle, JD, Chief of Staff, White House Office
of National Drug Control Policy (ONDCP), and Member, Rx Summit
National Advisory Board

Disclosures
• Laurie Lovedale, MPH, CPS II; Dwight Holton, JD; E. Douglas
Varney; Karen Edwards, PhD; and Regina M. LaBelle, JD, have
disclosed no relevant, real or apparent personal or
professional financial relationships with proprietary entities
that produce health care goods and services.

Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
– Carla Saunders – Speaker’s bureau: Abbott Nutrition

Learning Objectives
1. Specify benefits of collaboration and
coordination among entities engaged in Rx
drug abuse.
2. Describe a method for empowering
communities to tailor an effective local
response to Rx drug abuse.
3. Explain how data can be used to mobilize the
resources needed to combat Rx drug abuse.

Collaboration, Coordination and
Data: Three Keys for State Progress
Laurie Lovedale, MPH, CPS II
Manager, Prescription Drug Abuse
Prevention Program
Peer Assistance Services

Disclosure Statement
• Laurie Lovedale, MPH, CPS II has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services

Session Objectives
• Specify benefits of collaboration and
coordination among entities engaged in Rx
drug abuse.
• Describe a method for empowering
communities to tailor an effective local
response to Rx drug abuse.
• Explain how data can be used to mobilize the

Strategic Planning Process in Colorado
1st NGA Policy Academy
CO Team includes representation
from CDHS, CDPHE, DPS, DORA, HCPF,
AG’s Office and Governor’s Office
CO Team identifies focus areas
for state strategic plan
CO Roundtables
185 experts and stakeholders
convene including state health
officials, health professionals,
academics, professional membership
organizations, law enforcement
representatives and policymakers
Draft of initial recommendations,
expanding on major focus areas
CO In-State Policy Academy
40 decision-makers and
stakeholders reconvene
Initial recommendations finalized
and timeline established
through May 2014
2nd NGA Policy Academy
CO Team shares action plan and
lessons learned with the six other
states participating in the
NGA Policy Academy
CU School of Pharmacy
recommendation to coordinate
consortium, house strategic plan,
make and track progress








Prescriber
and Provider
Education
Workgroup
Agency Co-Chair:
Cathy Traugott, HCPF
Univ Co-Chair:
Lee Newman, MD
PDMP
Workgroup
Agency Co-Chair:
Chris Gassen, DORA
Univ Co-Chair:
Jason Hoppe, DO
Safe Disposal
Workgroup
Agency Co-Chair:
Shannon Breitzman,
CDPHE
Univ Co-Chair:
Sunny Linnebur,
PharmD
Public
Awareness
Workgroup
Agency Co-Chair:
Stan Paprocki, OBH
Univ Co-Chair:
Carol Runyan, PhD
Treatment
Workgroup
Agency Co-Chair:
Denise Vincioni, OBH
Univ Co-Chair:
Paula Riggs, MD
Data/Analysis
Workgroup
Agency Co-Chair:
Barbara Gabella,
CDPHE
Univ Co-Chair:
Ingrid Binswanger, MD
Coordinating Center
CU School of Pharmacy
+Coordinating Committee
Governor
Policy
Lead
CO Attorney
General
Substance Abuse
Trend & Response
Task Force
CO
Legislature
Colorado Consortium for Prescription Drug Abuse Prevention
A coordinated, statewide, interuniversity/interagency network
LEGEND
= New
= Existing
Subcommittee

Prescription Drug Abuse Prevention
Program
• A State Priority Initiative funded by the
Colorado Office of Behavioral Health
• 5-year funding cycle
• Funded for over 20 years

2010-2015 Program Objectives
• Increase awareness of the problem
• Increase availability of medication disposal
programs statewide
• Encourage responsible prescribing practices
• Encourage patient responsibility
• Track data and trends

Accomplishments of the Colorado
Consortium for Prescription Drug
Abuse Prevention
1st Year

PDMP Work Group
• HB14‐1283: PDMP Enhancement Bill
• Mandatory PDMP registration for all CO DEA registered
prescribing practitioners & all CO licensed pharmacists
• Allows PDMP‐registered prescribing practitioners &
pharmacists to delegate access
• Allows the PDMP to send Unsolicited Reports (“Push
Notices”) to affected prescribing practitioners and
pharmacies
• As with out‐of‐state prescribing practitioners in the
past, it now allows out‐of‐state pharmacists to obtain
patient information from the PDMP;

• Provides Colorado Department of Public
Health and Environment access to the PDMP
for public health purposes
• Creates of a PDMP Taskforce – to further study
the effectiveness of the PDMP.

Public Awareness Work Group
• Statewide social
marketing campaign
• All adult Coloradoans
18+
• Pre/post survey
– Safe Use
– Safe Storage
– Safe Disposal
– Advocacy

Safe Disposal Work Group
• Developed guidelines for safe disposal in
Colorado
• Developed brochure to convey guidelines to
public
• Distributed brochure to major pharmacy chains in
Colorado and at multiple community events
• CDPHE expanded number of safe disposal sites
through grant‐funded provision of lock boxes to
law enforcement agencies
• Created map of disposal sites

Providers Education Work Group
Online Training & Education
for Providers
• Developed at the Colorado School
of Public Health in the Center for
Worker Health & Environment
• Launched in Fall 2012
• Supported by an unrestricted
educational grant from Pinnacol
Assurance
WWW.PAINMANAGEMENTCME.ORG

Providers Education Work Group
New Prescriber
Education
• Dentists
• Veterinarians
• Physicians
Dr. Brett Kessler, President, Colorado Dental
Association

DORA Boards
• Nursing
• Medical
• Pharmacy
• Dental
• Nurse Physician
Advisory Taskforce
(NPATCH)

Data Analysis Work Group
• Created a data inventory
• Prioritized five indicators from the inventory
– to track over time
• Specified a data dashboard

• Naloxone Work Group – Standing Orders Bill
• Explore integrating EHR with PDMP
• Expanding public awareness campaign to
target certain populations

National Rx Drug Abuse Summit:
Oregon’s Regional Summit Agenda to
Reduce Abuse, Misuse and Overdose
Dwight Holton Chief Executive Officer Lines for Life

• Dwight Holton has disclosed no relevant, real
or apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services

Lines for Life Team
• 14 Masters Level Counselors
• 120 Highly Trained Volunteers
• 20 Teens on YouthLine
• Nationally Accredited Suicide Line
• De-Escalate 98% of calls on LifeLine
• Trainers of Trainers

Lines for Life Crisis Lines Overview

The Oregon Epidemic
• Oregon ranks #1 In Non-Medical Use of
Opioids (2010-2011, SAMSHA NSDUH)
• Over 3 million opioid prescriptions in 2013
(54% of all Rx) (OHA Injury and Violence Prevention Fact Sheet)
– 1.88 M hydrocodone
– 1.15 M oxycodone
• Over 100 million opioid pills every year
– Population: 3.9 million
– 25 pills for every man, woman and child

Opioid Deaths
• 46 people die every day (Centers for Disease Control)
• ~110 Oregonians in 2014
– 150 Oregonians in 2013
– 193 in 2011
– 170 in 2012

Source: SAMHSA Treatment Episode Data Set
(TEDS), 2000-2010
28,326
37,649
45,882
52,664
60,824
71,048
82,359
98,386
122,185
142,124
157,171
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
20002001200220032004200520062007200820092010
More Than 5-Fold Increase
In Treatment Admissions For
Prescription Painkillers
In the Past Decade
12
10
8
6
4
2
0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
*Deaths are those for which poisoning by drugs (illicit, prescription, and
over-the-counter) was the underlying cause.
Drug OD in the US Have More
Than Tripled since 1990 and INCREASES Greater for
Women (Five-FOLD)
National Vital Statistics System. Drug Overdose Death Rates by State 2008.
100 people die from drug
overdoses every day in the US
CDC Vital Signs, July 2013.
Slide from Presentation of Dr. Nora Volkow, Director, Natl Institute of
Drug Abuse, April 22, 2014 National Rx Summit

Regional Summit Objectives
1. Decrease pills in circulation
2. Promote PDMP
3. Patient education
4. Change attitudes & perceptions
5. Reduce the volume of unwanted pills
6. Improve & expand access to
treatment services

Core Strategy
• Regional summits to develop regional action plans to
reduce abuse
• Include all relevant stakeholders
• CCO
• Third party payers
• Hospitals/systems
• Treatment providers
• Prescribers
• Prevention
• Public health
• Law enforcement

Prescription Rates Across Oregon
County All Opioids Oxycodone HydroC. Benzo+Opiod
Statewide 233.8 86.2 174.1 47.1
Malheur 181.1* 29.0* 163.6 36.9
Baker 218.5 58.1 175.0 40.4
Clatsop 270.6 124.6^ 184.2 49.9
Curry 279.1 59.8 238.1^ 63.6
Harney 219.4 83.8 156.1 47.7
Josephine 298.7^ 97.7 231.8 72.4^
Umatilla 204.7 61.6 167.4 30.7*
Clackamas 240.7 100.3 170.5 46.3
Multnomah 224.7 89.0 161.4 39.9
*= lowest in Oregon
^= highest in Oregon

Regional Summit Agenda
• State of the state
• State of the region
• PDMP data and survey data
• Highlight Key Initiatives in Oregon
• Identify barriers to reducing abuse:
• Better Prescribing
• Reducing Volume of Unwanted Pills
• Improving and Expanding Treatment
• Expanded & Better Use of the PDMP

Regional Summit Outcomes
• Regional Plans to Reduce Misuse, Abuse
and Overdose
• Policy Recommendations to Governor
and Legislature
• Improved patient, provider and system education

Regional Survey Instrument
• Goals
– Identify existing regional strategies that should be supported
– Establish a baseline regarding use of evidenced based practices
and standards to reduce abuse, misuse and overdose
– Identify and understand unique regional opportunities
– Identify and understand unique regional challenges
• Participants
– Systems
– Clinics
– Public Health Officials
– Providers

Reducing the Pills in Circulation
for each: Identify Barriers and Solutions
• Prescribing Practices
– Rx Guidelines
• Expanding use of guidelines
• Baseline components of effective guidelines
– Use of the PDMP
• Expanding use
• Standard of Care?
– Other?
• Reimbursement Strategies/Incentives
– Rx bias in reimbursement?
– Reimbursement cap?
– Other?

Reducing the Pills in Circulation (2 of 2)
for each: Identify Barriers and Solutions
• Expanding Use of Non-Opioid Therapies
– Non-opioid Therapies (movement, yoga,
acupuncture)
• Primary Care Provider education
– In practice today
– In medical education
• Access/availability of providers
• Reimbursement incentives
– Moving non-opioid therapies above the line
– Addressing any reimbursement bias
– Alternative Pain Clinic Model

Improving Treatment and
Access to Treatment
• Improving access to medication assisted therapies
– Suboxone
• Reimbursement strategies
• Improving provider access
– Expanded certification
– Hub model
– Naloxone
• Co-prescription strategies
• Law enforcement / first responder access
• Post Naloxone intervention strategies

ORCRM
Oregon Coalition for
Responsible Use of Meds
Dwight Holton
CEO Lines for Life
971.244.1371
DwightH@Linesforlife.org

Collaboration, Coordination and
Data: Three Keys for State Progress
Doug Varney, Commissioner
Karen Edwards, Ph.D., Research Director
Tennessee Department of Mental Health
and Substance Abuse Services
and Substance Abuse Services
Varney & Edwards, 2/24/2015

Disclosure Statements
• Doug Varney, Commissioner, has disclosed no
relevant, real or apparent personal or professional
financial relationships with proprietary entities that
produce health care goods and services.
• Karen Edwards, Ph.D., has disclosed no relevant, real
or apparent personal or professional financial
relationships with proprietary entities that produce
health care goods or services.
and Substance Abuse Services 2

Learning Objectives
1. Specify benefits of collaboration and coordination
among entities addressing Rx drug abuse.
2. Describe a method for empowering communities to
tailor an effective local response to Rx drug abuse.
3. Explain how data can be used to mobilize the

Gov. Haslam announces Prescription for Success

Building an initiative:
Prescription for Success
Governor
focus on
collaboration
Public Safety
Subcabinet
Prescription
for Success

Department of Safety and Homeland Security
Department of Mental Health and Substance Abuse Services
Department of Children’s Services
Tennessee Bureau of Investigation
Department of Correction
Board of Probation and Parole
Military Department
Department of Health
Governor’s Highway Safety Office
(Department of Transportation)
Office of Criminal Justice Programs
(Department of Finance & Administration)
Law Enforcement Training Academy
(Department of Commerce & Insurance)
Additional Staff Support:
Tennessee Criminal Justice Coordinating Council
National Governors Association Center for Best Practices
The Center for Non-Profit Management
PUBLIC SAFETY SUBCABINET WORKING GROUP

PUBLIC SAFETY ACTION PLAN
Contains Three Key Initiatives/Focus Areas to Curb Crime and
Help Create a Climate for Job Growth in Tennessee
Communities.
Violent Crimes Repeat Offenders
An Atmosphere that
Encourages
Investment
And Job Growth

o All prescribers must access the controlled substance
database prior to prescribing an opioid or benzodiazepine
o Dispensers must check the database if a person tries to
obtain a prescription for a controlled substance for
fraudulent, illegal, or medically inappropriate purposes
o Increases penalties for doctor shopping from a Class A
misdemeanor to a Class E felony
o Allows data sharing from the prescription monitoring
database
Prescription Drug Safety Act of 2012

o Neonatal Abstinence Syndrome Working Group
o Substance Abuse Data Task Force
 Agreement to share data
 Standard definitions
 Footnote data source
 Review by data “owner” before sharing
Safety Subcabinet Working Groups

Prescription for Success
Statewide Strategies to Prevent and Treat
the Prescription Drug Abuse Epidemic
in Tennessee
Prescription For Success Partners
• Tennessee Department of Health
• Tennessee Department of Children’s
Services
• Tennessee Department of Correction
• Tennessee Department of Safety &
Homeland Security
• Tennessee Department of Health Care
Finance Administration (TennCare)
• Tennessee Bureau of Investigation
• U.S. Department of Justice Drug
Enforcement Administration

PRESCRIPTION FOR SUCCESS
7
Goals
1. Decrease the number of
Tennesseans that abuse controlled
substances.
2. Decrease the number of
Tennesseans who overdose on
controlled substances.
3. Decrease the amount of
controlled substances
dispensed in Tennessee.
4. Increase access to drug
disposal outlets in Tennessee.
5. Increase access and quality of
early intervention, treatment
and recovery services.
6. Expand collaborations
and coordination among
state agencies.
7. Expand collaboration
and coordination with
other states.
33 Strategies
Measures of Success

TELL THE STORY OF PRESCRIPTION
DRUG ABUSE IN TENNESSEE
Using data to:

Telling the Story of Prescription Drug
Abuse in Tennessee
• Identify the problem
• Answer questions
• Track success

IDENTIFY THE PROBLEM
Use data to:

Drug Overdose
342
391
422
484
660
753
868
963 972
924 929
1,059 1,062
1,094
0
200
400
600
800
1,000
1,200
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Drug overdose deaths in Tennessee: 1999-2012
(Source: Office of Policy, Planning and Assessment,
Tennessee Department of Health - Death Certificates)

Admissions to Publicly Funded Substance Abuse Treatment
TN: Opioids
TN: Alcohol
US: Opioids

Neonatal Abstinence Syndrome

ANSWER QUESTIONS
Use data to:

How does substance abuse for young adults change over time?
How does Tennessee compare to the United States?
United States Tennessee
*NOTE: Tennessee began disaggregating heroin admissions from prescription opioids in July 2009.
Substance abuse treatment admissions among young adults, ages 18-24,
by primary substance of abuse: Tennessee and the United States from 2002 to 2011
(Data source: TEDS-A)
28.5%
15.3%
16.8%
4.4%
24.7%
25.8%
0.0%
2.3%*
15.5%
41.4%
14.5% 10.9%
0%
25%
50%
75%
100%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
34.6%
26.0%
7.4%
3.2%
30.3%
29.7%
13.5%
17.6%
2.4%
14.6%
11.9% 8.9%
0%
25%
50%
75%
100%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Where in Tennessee is prescription drug abuse a problem?
Percent of TDMHSAS funded treatment admissions by county when prescription opioids are named as a substance of abuse
(Data Source: TDMHSAS, 2011-2014)
FY 2011
FY 2014

TRACK SUCCESS
Use data to:

Cumulative number of high utilization patients* by quarter in the
Controlled Substances Monitoring Database (CSMD): CY 2011 to 2014
1,950 2,246
1,785 1,374
2,413 2,218
1,533
1,404
2,515 2,261
1,533
1,278
2,352
1,940
1,335
1,307
0
2,000
4,000
6,000
8,000
10,000
CY2011 CY2012 CY2013 CY2014
CountofHighUtilizationPatients
Q1 Q2 Q3 Q4
*Note: Patients filled prescriptions from 5 or more prescribers at 5 or more
dispensers within 90 days.
Source: Tennessee Department of Health
Decrease Doctor Shopping

Increase Disposal Boxes
Source: Tennessee Department of Mental Health and Substance Abuse Services
January 2012 to December 2014

Increase Safe Housing Options for Individuals in Recovery
61
163
0
40
80
120
160
200
Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14
Capacity(beds)
Monthly capacity of Oxford Houses in Tennessee:
July 2013 to December 2014
Source: Tennessee Department of Mental Health and Substance
Abuse Services

Increase Access to Recovery Courts
1,284
1,612
2,057
2,267 2,267
2,542 2,542
-
500
1,000
1,500
2,000
2,500
3,000
Q2 Q3 Q4 Q1 Q2 Q3 Q4
CY2013 CY2014
Capacity
Capacity of adult recovery (drug) courts:
Q2 CY 2013 to Q4 CY 2014
Source: Tennessee Department of Mental Health and Substance
Abuse Services

Questions?
• Prescription for Success:
http://tn.gov/mental/prescriptionforsuccess/
• For more information contact:
Karen Edwards, Ph.D.
Karen.Edwards@tn.gov
615-532-3648

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